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Radical resection for craniopharyngiomas in children: surgical technique and clinical results
Patrick Dhellemmes1, Matthieu Vinchon
1Pediatric Neurosurgery, University Hospital, Lille, France. p-dhellemmes@chru-lille.fr
Insights
Pediatric craniopharyngiomas are aggressive tumors. While total resection offers the best oncological outcome, balancing surgical risks and functional preservation is crucial for long-term patient management.
Area of Science:
- Pediatric Neurosurgery
- Pediatric Oncology
- Endocrinology
Background:
- Craniopharyngiomas are benign suprasellar tumors.
- These tumors present a surgical dilemma due to recurrence risk and aggressive resection complications.
- Pediatric craniopharyngiomas exhibit particularly aggressive behavior.
Purpose of the Study:
- To review surgical outcomes for pediatric craniopharyngiomas.
- To evaluate the efficacy of total versus subtotal resection.
- To assess long-term functional outcomes and complications.
Main Methods:
- Retrospective review of 37 pediatric craniopharyngioma cases.
- Analysis of first-hand surgical cases and follow-up data.
- Evaluation of resection extent, recurrence rates, and functional deficits.
Main Results:
- Total resection was achieved in 65% of initial surgeries.
- Tumor progression occurred in 93% after subtotal resection vs. 43% after total resection.
- Visual deficits improved/stabilized in most, but worsened in 30%; 48% experienced obesity; all required hormonal replacement.
Conclusions:
- Total resection provides the best oncological results for pediatric craniopharyngiomas.
- High functional morbidity necessitates careful consideration of surgical approach.
- Alternative therapeutic strategies and lifelong management are essential.
Abstract:
Craniopharyngiomas are benign suprasellar tumors; however, their tendency to recur after resection and the risks associated with aggressive tumor resection pose a surgical dilemma. We reviewed our series of operated craniopharyngiomas and selected pediatric cases operated as first-hand cases and followed in our institution. We studied 37 cases. Resection was total in 65%. No patient died in the operative period; three patients died 6 months to 8 years after surgery of endocrine-related cause or sudden death. Tumor progression occurred in 93% of cases after subtotal resection versus 43% after total resection. Among 20 operations for recurrence, total resection was achieved in 45%. Visual deficits were often stabilized or improved after surgery, but worsened in 30% because of surgical damage or tumor recurrence. Fifty-nine percent of patients follow a normal school curriculum. All patients have some degree of pituitary hormonal replacement and 48% have obesity. Hypothalamic damage was generally associated with intraventricular extension of the tumor recurrence and re-operations, especially through combined approaches. Craniopharyngiomas in children are particularly aggressive tumors. Although the best oncological results are obtained with total resection, in some cases the functional price of surgery may be too high and alternative techniques should be proposed. The life-long management of these patients requires that the best use is made of all potential therapeutic tools.
